Tablets in the exam room deliver improved efficiency & patient communication - who would have thought?

Posted by Dan Mazanec, MD on Jul 12, 2016 9:47:36 AM

The use of mobile technology use in health care has exploded in the past 5 years with 87% of physicians reporting using a mobile phone or tablet in their clinical work. Until recently, studies have shown physicians used mobile devices primarily for search and continuing medical education. Clinicians now have access to a wide array of medical apps providing point of care access to medical calculators, clinical decision support tools, and literature search portals. I've previously described the use of an antibiotic stewardship "app" to improve drug usage and reduce the risk of bacterial resistance. A logical next step is movement of the tablet into the patient encounter itself for real time documentation with decision support, patient education, and ordering. Two new studies provide strong evidence that using a tablet computer linked to the EMR in either an outpatient or hospital setting improves provider efficiency and increases time with patient, actually improving patient satisfaction.

More productive, satisfied clinicians

Schooley B, et al recently reported the impact of a pilot program introducing mobile tablet computers (Microsoft Surface) connected to the electronic medical record (EMR), computerized physician order entry system (CPOE), and imaging archive system (PACS) in the outpatient practices of a large health care organization in the Southeast U.S. The 42 volunteer providers were interviewed in person using a structured survey instrument at least 6 months after receiving the tablet. More than 85% of practitioners worked in the outpatient area. About 70% were generalists and more than 40% had been in practice more than 16 years. The majority of participants reported improved overall efficiency (57.1%), reduced time documenting (53.6%) and increased productivity (53.8%). 57.1% reported the device improved their workday and nearly 50% reported reduced time after work completing documentation. A major perceived barrier to use of tablet computers is patient acceptance and satisfaction. Significantly, more than 80% of providers felt patient satisfaction with the care experience was either unchanged (42.1%) or positive (44.7%). When asked specifically about the device, portability was rated as the most important feature, allowing for documentation at clinician convenience and shortening after clinic hours in the office. The touchscreen and ability to run the full EMR were ranked second and third most important.

More face time with the patient

A second study published last month reported the results of a survey of 14 neurologists after 7 weeks of using a tablet (iPad mini) running a mobile EMR exclusively in a hospital setting. Tablet functionality was limited in that physicians were not able to enter orders or edit clinical notes. Accessing patient data was also cumbersome as users were required to enter a 6 digit code to unlock the tablet and then enter a second password to access the software. Despite these limitations, tablet use accelerated preparation for ward rounds by speeding access to patients' medical records resulting in increased physicians' bedside time, i.e., less time hunting for data and more time talking to patients.Significant time saving was also noted in completing post-rounding work. Digital tracking of tablet use in a subset of physicians demonstrated time savings of about 35 minutes per ward rounds. Physicians reported high degrees of satisfaction particularly with accelerated data and imaging retrieval. Surveyed clinicians were highly motivated to continue use of the tablets during future ward rounds.

Positive patient reaction

Neither of these studies directly evaluated patients' attitudes toward use of a tablet computer by their physician. However, the results of an earlier exit survey of 96 patients treated in the Department of Family Medicine at the University of Virginia after a visit with a physician using a tablet computer are revealing. Almost 90% of patients felt they could talk as easily with their doctor using a tablet as before. 84% stated their interaction with their doctor had not become less personal. Only 4.3% of patients disliked the idea of a doctor with a tablet computer. 91% of patients didn't feel the physician was watching the screen rather than them.

Imagine the possibilities

These studies support continued innovation in the use of mobile technology in health care. Even with what could be described as first generation software, physician satisfaction was high and productivity increased. Patient acceptance was excellent. Opportunities to creatively provide clinicians with user-friendly software that links with existing EMR data and eases documentation and ordering while preserving authentic eye contact and interaction with patients are huge. With the accelerated push to value based medical practice in the era of MACRA, seamlessly integrating evidence informed clinical decision support and performance metric capture at the point of care is essential.

About Dan Mazanec, MD

Prior to joining Dorsata in 2016, Dan Mazanec, MD was the Associate Director of the Center for Spine Health at the Cleveland Clinic. Board certified in internal medicine and rheumatology, he has been a leader in the development of the emerging specialty of Spine Medicine. A frequent lecturer at international and national meetings, he has authored more than 70 book chapters and papers. He is an active member of the North American Spine Society with a particular focus on the development of evidence-based clinical guidelines as a member of the Clinical Guidelines Committee and the role of non- surgical care as chairman of the Rehabilitation Interventional Medical Spine Committee.
Dan led the development of the Cleveland Clinic Spine CarePath which merges evidence-informed clinical management of spine disorders with patient-entered clinical outcome data focusing on optimizing value. He was the clinical lead for technologic enablement of the CarePath in the EMR and the implementation of the Spine Carepath across the entire Cleveland Clinic Health System.